Introduction: Neutrophil-lymphocyte ratio (NLR) is one of the laboratory biomarkers used in clinical practice to predict severity and mortality of acute pancreatitis (AP), however, there is currently insufficient information about the changes of NLR in the dynamics in relationship with other clinical and laboratory data. Aims: To assess the relationship between NLR values and other demographics, clinical and simple laboratory data in patients with acute pancreatitis. Methods: The data of two hundred twenty-nine patients with AP were analyzed. All patients were divided into two groups: the group with a positive outcome and the group with a fatal outcome. NLR was counted on the 1st, 3rd and 5th day after admission in each group. The dynamics of NLR index by groups and days, as well as its correlation with other 18 simple laboratory parameters were evaluated. Results: The level of NLR rate itself was significantly higher on the 1st, 3rd and 5th day in the group with the fatal result compared with the group with the positive result (p < 0.05). In patients with AP with the positive result of treatment, there was a gradual decrease in the rate between the 1st and the 3rd day (-21.8%) (p < 0.05). The overall dynamics of the indicator between the 1st and the 5th day was -21.5%. In contrast to the group of patients with the fatal outcome, despite the infusion therapy, there was an increase in NLR rate between the 1st and 3rd day of +15.7%. The overall dynamics between the 1st and 5th day was -34.0%. A significant negative relationship of the Spearman's rank correlation coefficient between NLR on the 1st and 3rd day with the fatal outcome was revealed. The highest reliability of this indicator was found on the 3rd day after admission (p < 0.0001). In the group of patients with a positive result, a correlation between NLR on the 1st day and stabs on the 1st day, segmental forms on the 1st day, serum amylase on the 1st day was found. A very high correlation was found with the level of lymphocytes on the 1st day (rs = -0.98, p < 0001). In the group of patients with the fatal outcome, a statistically significant correlation (p < 0.05) of moderate strength was found between the value of NLR and the following indicators: glucose level on the 1st day, total protein on the 5th day, prothrombin index on the 5th day. A high correlation was found with the level of segmental forms on the 1st day (rs = 0.7) and a very high correlation with the level of lymphocytes on the 1st day (rs = -0.99). Conclusions: There was a significant increase in NLR on the 1st, 3rd, and 5th day in the group of patients with AP with the fatal outcome compared with the group of patients with AP with the positive result. Elevated NLR levels on the 1st and 3rd day seem to be associated with hospital mortality in patients with AP. No correlation was found between NLR rate and clinical data in the group with fatal outcome. The main indicators among simple laboratory parameters for determining the predictors of lethal outcome in AP in different periods after hospitalization were: the level of blood glucose, lymphocytes, total protein, serum amylase, prothrombin index.
References
1.
Wang Y, Fuentes HE, Attar BM, Jaiswal P, Demetria M. Evaluation of the prognostic value of neutrophil to lymphocyte ratio in patients with hypertriglyceridemia-induced acute pancreatitis. Pancreatology. 2017;17(6):893–7.
2.
Gezer NS, Bengi G, Baran A, Erkmen PE, Topalak ÖS, Altay C, et al. Comparison of radiological scoring systems, clinical scores, neutrophil-lymphocyte ratio and serum C-reactive protein level for severity and mortality in acute pancreatitis. Revista da Associação Médica Brasileira. 66(6):762–70.
3.
Jeon TJ, Park JY. Clinical significance of the neutrophil-lymphocyte ratio as an early predictive marker for adverse outcomes in patients with acute pancreatitis. World Journal of Gastroenterology. 2017;23(21):3883.
4.
Suppiah A, Malde D, Arab T, Hamed M, Allgar V, Smith AM, et al. The Prognostic Value of the Neutrophil–Lymphocyte Ratio (NLR) in Acute Pancreatitis: Identification of an Optimal NLR. Journal of Gastrointestinal Surgery. 2013;17(4):675–81.
5.
Khanna AK, Meher S, Prakash S, Tiwary SK, Singh U, Srivastava A, et al. Comparison of Ranson, Glasgow, MOSS, SIRS, BISAP, APACHE-II, CTSI Scores, IL-6, CRP, and Procalcitonin in Predicting Severity, Organ Failure, Pancreatic Necrosis, and Mortality in Acute Pancreatitis. HPB Surgery. 2013;2013:1–10.
6.
Robert JH, Frossard JL, Mermillod B, Soravia C, Mensi N, Roth M, et al. Early prediction of acute pancreatitis: Prospective study comparing computed tomography scans, ranson, glasgow, acute physiology and chronic health evaluation II scores, and various serum markers. World Journal of Surgery. 2002;26(5):612–9.
7.
Windsor JA. Assessment of the Severity of Acute Pancreatitis: No Room for Complacency. Pancreatology. 2008;8(2):105–9.
8.
Exam 2: A Conservative and Minimally Invasive Approach to Necrotizing Pancreatitis Improves Outcome. Gastroenterology. 2011;141(4):e23–4.
9.
Singh VK, Bollen TL, Wu BU, Repas K, Maurer R, Yu S, et al. An Assessment of the Severity of Interstitial Pancreatitis. Clinical Gastroenterology and Hepatology. 2011;9(12):1098–103.
10.
Banks PA, Bollen TL, Dervenis C, Gooszen HG, Johnson CD, Sarr MG, et al. Classification of acute pancreatitis—2012: revision of the Atlanta classification and definitions by international consensus. Gut. 2013;62(1):102–11.
11.
Li Y, Zhao Y, Feng L, Guo R. Comparison of the prognostic values of inflammation markers in patients with acute pancreatitis: a retrospective cohort study. BMJ Open. 2017;7(3):e013206.
12.
Staubli SM, Oertli D, Nebiker CA. Laboratory markers predicting severity of acute pancreatitis. Critical Reviews in Clinical Laboratory Sciences. 2015;52(6):273–83.
13.
O’Connell RM, Boland MR, O’Driscoll J, Salih A, Arumugasamy M, Walsh TN, et al. Red cell distribution width and neutrophil to lymphocyte ratio as predictors of outcomes in acute pancreatitis: A retrospective cohort study. International Journal of Surgery. 2018;55:124–7.
14.
Yakac A. The value of hematological parameters in acute pancreatitis. Turkish Journal of Trauma and Emergency Surgery.
15.
Kaplan M, Ates I, Oztas E, Yuksel M, Akpinar MY, Coskun O, et al. A New Marker to Determine Prognosis of Acute Pancreatitis: PLR and NLR Combination. Journal of Medical Biochemistry. 2018;37(1):21–30.
16.
Azab B, Jaglall N, Atallah JP, Lamet A, Raja-Surya V, Farah B, et al. Neutrophil-Lymphocyte Ratio as a Predictor of Adverse outcomes of Acute Pancreatitis. Pancreatology. 2011;11(4):445–52.
17.
Forget P, Khalifa C, Defour JP, Latinne D, Van Pel MC, De Kock M. What is the normal value of the neutrophil-to-lymphocyte ratio? BMC Research Notes. 2017;10(1).
18.
Petrescu G, Georgescu I, Surlin V. Is there a role for a new set of prognostic markers in acute pancreatitis? The Medical-Surgical Journal Revista medico-chirurgicala. 2020;124(1):70–8.
19.
Kong W, He Y, Bao H, Zhang W, Wang X. Diagnostic Value of Neutrophil-Lymphocyte Ratio for Predicting the Severity of Acute Pancreatitis: A Meta-Analysis. Disease Markers. 2020;2020:1–9.
20.
Cho SK, Jung S, Lee KJ, Kim JW. Neutrophil to lymphocyte ratio and platelet to lymphocyte ratio can predict the severity of gallstone pancreatitis. BMC Gastroenterology. 2018;18(1).
21.
Zhou H, Mei X, He X, Lan T, Guo S. Severity stratification and prognostic prediction of patients with acute pancreatitis at early phase. Medicine. 2019;98(16):e15275.
22.
Cifci M, Halhalli HC. The Relationship Between Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios With Hospital Stays and Mortality in the Emergency Department. Cureus. 2020;
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